Emergency Room Overcrowding: Making Ambulance Crews Wait

A patient calls 911. You respond, do an assessment, start an IV, put the patient on your stretcher and head for the emergency room. As you pull up to the emergency room, you see ambulances backed up in the emergency room driveway. This can only mean one...


To access the remainder of this piece of premium content, you must be registered with Firehouse. Already have an account? Login

Register in seconds by connecting with your preferred Social Network.

OR

Complete the registration form.

Required
Required
Required
Required
Required
Required
Required
Required
Required
Required

This practice may result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and raises serious concerns for patient care and the provision of emergency services in a community. Additionally, this practice may also result in violation of the Conditions of Participation for Hospitals.

"Under EMTALA, a patient is considered to have "presented" to a hospital when a patient arrives on hospital grounds (defined as the main hospital building and any hospital-owned property within 250 yards of the main hospital building) and a request is made on the individual's behalf for examination or treatment of an emergency medical condition. A patient who arrives via EMS meets this requirement when EMS personnel request treatment from hospital staff. Therefore, the hospital must provide a screening examination and stabilizing treatment, if necessary, to resolve the patient's emergency medical condition. CMS does not recognize the distinction some hospital staff are trying to make in identifying EMS versus hospital responsibility for a patient already in the facility."

A System in Trouble

Later in the document, CMS writes, "Our office recognizes the enormous strain and crowding many hospital emergency departments face every day. However, this practice is not a solution. "Parking" patients in hospitals and refusing to release EMS equipment or personnel jeopardizes patient health and impacts the ability of the EMS personnel to provide emergency services to the rest of the community."

The practice of parking patients in emergency rooms and using EMS equipment and staff to take watch over and, in some cases, render care to patients is becoming more commonplace. Unfortunately, it is a poor practice that robs a community of its EMS resources, delays responses to 911 calls and puts an unnecessary strain on EMS personnel.

If this is a problem in your community, your fire chief or EMS chief should address the issue with hospital administrators. If it is happening at multiple hospitals in your community, it may be necessary to get all the players to the table to find a region-wide solution. The alternative is not attractive. An ambulance sitting in a parking lot for hours with a patient on your stretcher does no good for the patient, EMS personnel or the community.


Gary Ludwig, MS, EMT-P, a Firehouse contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 28 years of fire-rescue service experience, and previously served 25 years with the City of St. Louis, retiring as the chief paramedic from the St. Louis Fire Department. Ludwig is vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally. He can be reached through his website at www.garyludwig.com.